不同手术模式治疗浅表性食管鳞癌术后生活质量比较

Comparison of postoperative quality of life between different surgical modes for superficial esophageal squamous cell carcinoma

目的比较超级微创手术(SMIS)、微创食管切除术(MIE)和传统开放食管切除术(OE)治疗浅表性食管鳞癌(SESCC)术后生活质量的差异。方法选取2015年1月至2017年12月在解放军总医院第一医学中心消化内科及胸外科分别接受SMIS及食管切除术的SESCC患者,按手术模式可细分为SMIS组,MIE组,OE组。以EORTC QLQ-C30问卷及QLQOES18食管癌特异性问卷评价比较3组患者的术后生活质量。结果SMIS组、MIE组、OE组患者完成问卷的比例分别为:74.7%(65/87)、73.1%(38/52)和61.8%(21/34)。QLQ-C30问卷中,MIE组和OE组的术后恶心/呕吐评分(P=0.007,P=0.030)和疼痛评分(P=0.039,P=0.003)均明显高于SMIS组,MIE组的腹泻评分、经济影响显著高于SMIS组(P=0.017,P=0.001),OE组食欲减退评分明显高于SMIS组(P=0.013)。QLQ-OES18问卷中,MIE组和OE组的反流评分(P<0.001,P=0.003)和梗阻评分(P=0.033,P=0.044)均明显高于SMIS组,MIE组的吞咽困难较SMIS组显著(P=0.038),OE组的进食问题较SMIS组更明显(P=0.030)。MIE组和OE组的生活质量评分没有明显差异(P>0.05)。结论较之MIE及OE,SMIS治疗SESCC术后生活质量更好,而MIE与OE远期生活质量无明显差异。SMIS作为一种新的手术模式,未来也将成为新时代医学发展的方向。

Objective To compare the quality of life after different surgical modes for superficial esophageal squamous carcinoma(SESCC).Methods SESCC patients who underwent SMIS and esophagectomy in department of Gastroenterology and Department of Thoracic Surgery of the First Medical Center of PLA General Hospital from January 2015 to December 2017 were selected and divided into SMIS group,MIE group,and OE group according to surgical mode.EORTC QLQ-C30 and QLQ-OES18 esophageal cancer specific questionnaire were used to evaluate the quality of life of patients in the three groups.Results The proportions of patients completing the questionnaire in SMIS group,MIE group and OE group were 74.7%(65/87),73.1%(38/52)and 61.8%(21/34),respectively.In QLQ-C30,postoperative nausea/vomiting score(P=0.007,P=0.030)and pain score(P=0.039,P=0.003)were significantly higher in the MIE and OE groups than in the SMIS group.The diarrhea score and financial problem in MIE group were significantly higher than those in SMIS group(P=0.017,P=0.001),and the appetite loss in OE group was significantly higher than that in SMIS group(P=0.013).In QLQ-OES18,the reflux score(P<0.001,P=0.003)and obstruction score(P=0.033,P=0.044)in MIE and OE groups were significantly higher than those in SMIS group.Dysphagia was significantly higher in the MIE group than in the SMIS group(P=0.038),and eating problems were more pronounced in the OE group than in the SMIS group(P=0.030).There was no significant difference in quality of life between MIE group and OE group(P>0.05).Conclusion SMIS was associated with better postoperative quality of life than MIE and OE,but there was no significant difference in long-term quality of life between MIE and OE.As a new surgical mode,SMIS will become a development direction for medicine in the future.